Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 28, 2021; 27(4): 336-344
Published online Jan 28, 2021. doi: 10.3748/wjg.v27.i4.336
Clinic-pathological features of metabolic associated fatty liver disease with hepatitis B virus infection
Ming-Fang Wang, Bo Wan, Yin-Lian Wu, Jiao-Feng Huang, Yue-Yong Zhu, You-Bing Li
Ming-Fang Wang, Department of Liver Research Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, Fujian Province, China
Bo Wan, Institute of Neurology, University College London, London WC1N 3BG, United Kingdom
Yin-Lian Wu, Jiao-Feng Huang, Yue-Yong Zhu, You-Bing Li, Department ofLiver Research Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, Fujian Province, China
Author contributions: Wang MF and Li YB designed the study; Huang JF and Wu YL collected and analyzed the data; Wang MF and Wan B drafted the manuscript; Zhu YY and Li YB critically revised the manuscript; Wang MF and Wan B contributed equally to this work; all authors approved the final version of the manuscript prior to submission.
Supported by Chinese National 13th Five-Year Plan's Science and Technology Projects, No. 2017ZX10202201.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the First Affiliated Hospital of Fujian Medical University in accordance with the Declaration of Helsinki.
Conflict-of-interest statement: The authors have no conflict of interest to declare.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: You-Bing Li, PhD, Associate Chief Physician, Department of Liver Research Center, The First Affiliated Hospital of Fujian Medical University, No. 20 Chazhong Road, Taijiang District, Fuzhou 350005, Fujian Province, China. liyoubing1976@sina.com
Received: October 9, 2020
Peer-review started: October 9, 2020
First decision: December 3, 2020
Revised: December 11, 2020
Accepted: December 22, 2020
Article in press: December 22, 2020
Published online: January 28, 2021
Processing time: 107 Days and 15.1 Hours
Abstract
BACKGROUND

Metabolic associated fatty liver disease (MAFLD) is a novel concept proposed in 2020.

AIM

To compare the characteristics of MAFLD and MAFLD with hepatitis B virus (HBV) infection.

METHODS

Patients with histopathologically proven MAFLD from a single medical center were included. Patients were divided into MAFLD group (without HBV infection) and HBV-MAFLD group (with HBV infection). Propensity score matching was utilized to balance the baseline characteristics between two groups.

RESULTS

A total of 417 cases with MAFLD were included, 359 (86.1%) of whom were infected with HBV. There were significantly more males in the HBV-MAFLD group than in the MAFLD group (P < 0.05). After propensity score matching, 58 pairs were successfully matched with no significant differences found in gender, age, body mass index, lipid levels, liver enzymes, and the other metabolic associated comorbidities between the two groups (P > 0.05). The rank sum test results showed that the degree of liver steatosis in the MAFLD group was more severe than that in the HBV-MAFLD group, while the degree of inflammation and fibrosis in the liver was less severe (P < 0.05). In multivariate analysis, HBV infection was associated with significantly lower grade of hepatic steatosis [odds ratio (OR) = 0.088, 95% confidence interval (CI): 0.027-0.291] but higher inflammation level (OR = 4.059, 95%CI: 1.403-11.742) and fibrosis level (OR = 3.016, 95%CI: 1.087-8.370) after adjusting for age, gender, and other metabolic parameters.

CONCLUSION

HBV infection is associated with similar metabolic risks, lower steatosis grade, higher inflammation, and fibrosis grade in MAFLD patients.

Keywords: Fatty liver disease; Metabolic associated fatty liver disease; Hepatitis B virus; Biopsy; Clinic-pathological features

Core Tip: Metabolic associated fatty liver disease (MAFLD) is a novel concept proposed in 2020 aiming to replace the previous definition of non-alcoholic fatty liver disease. Patients with MAFLD have different features from those with non-alcoholic fatty liver disease because MAFLD does not require the exclusion of other chronic liver disease, such as hepatitis B virus (HBV) infection. In this study, we compared the characteristics of patients with and without HBV infection in a biopsy-proved MAFLD cohort. The results of this study involving 417 participants showed that cases with HBV-MAFLD had similar metabolic features as pure MAFLD, and the presence of HBV infection was associated with lower steatosis grade but higher inflammation and fibrosis grade in MAFLD. These results highlight the importance of the monitoring and managing HBV infection in MAFLD.